Maggie L. Shaw
Results from an analysis of patients with breast cancer and coronavirus disease 2019 (COVID-19), from Institut Curie hospitals in France, show that mortality is determined more by comorbidities than previous or current treatment for the cancer.
The authors of the study first set up their prospective registry on March 13, 2020, to cover all patient with breast cancer who had COVID-19 symptoms or radiologic signs of the virus. Data were collected on their history, tumor characteristics and treatments, COVID-19 symptoms, radiologic features, and outcomes. A COVID-19 diagnosis was confirmed through a positive RNA test via reverse transcription polymerase chain reaction (PCR) or an abnormal lung CT scan.
Seventy-six patients were included in the registry, which is 0.5% of the 15,600 patients with early stage or metastatic disease whom ICH has treated for breast cancer over the previous 4 months. Their ultimate outcomes were updated 2 days prior to data analysis on April 25. Of this entire cohort, 58 and 39 patients were tested for COVID-19 via PCR and/or CT, respectively.
COVID-19 was officially diagnosed in 59 of the patients: 41 through PCR and 18 through CT. At this point, fever and/or cough and ground-glass opacities were the most common clinical and radiographic indications, respectively, of having the virus. Thirty-seven of these patients have metastatic breast cancer, and of the 28 hospitalized, just 6 required admittance to the intensive care unit. The remaining 17 patients who only had symptoms did not need to be hospitalized.
Overall, just 4 of the 59 patients died from COVID-19. Most (76%) had or were recovering at data analysis. Of those who died, “all had significant noncancer comorbidities,” the authors noted. Hypertension and age older than 70 contributed the most mortality risk (both P <.05), with other notable comorbidities being obesity (17%), diabetes (17%), and heart disease (14%).
In fact, the study investigators could not find evidence linking previous radiation treatment or sequelae to lung injury sustained from COVID-19 infection (<10% vs >10%, Fisher's exact test P = .69). Twenty-five of the 28 patients requiring hospitalization “had less than 25% involvement of their lung volume,” the authors noted. This comes on the heels of an original prediction that “cancer patients with blood, lung, or metastatic cancers were reported to have the highest frequency of severe outcomes.”
“While our study cannot determine the incidence of COVID-19 infection among breast cancer patients, the small number of diagnosed cases suggests that breast cancer patients do not appear to be at higher risk than the general population,” the authors concluded. “Importantly, we found no trend in favor of a relationship between a history of breast and lymph node radiation therapy, radiation therapy sequela, and radiologic extent of disease or outcome.”
Moving forward, they suggest including comorbidities as an area of focus when investigating the risk of severe COVID-19 infection in patients, especially among patients with breast cancer, so that treatment guidelines can be formalized if and when a vaccine is proven effective.
Reference
Vuagnat P, Frelaut M, Ramtohul, et al. COVID-19 in breast cancer patients: a cohort at the lnstitut Curie hospitals in the Paris area. Breast Cancer Res. Published online May 28, 2020. doi:10.1186/s13058-020-01293-8.
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